Izincomo ezivela eNsizakalo Yezempilo Yomphakathi wase-US
Ngo-1996, i-US Public Health Service (USPHS) yakhipha isiqondiso sokuqala mayelana nokusetshenziswa kwezidambisigciwane (ama-ARV) njenge- post-exposure prophylaxis (i-PEP) ezimweni zokutholakala komsebenzi we-HIV ngabasebenzi bezempilo (HCP).
Ngo-Agasti 2013, i-USPHS ivuselele imihlahlandlela yesine, isekela izincomo zabo ngokutholakala nokusebenza kwama-ARVs asanda kuzalwa, kanye nolwazi olusesikhathini samanje ekuphepheni kwesikhathi eside sama-ARV avunyelwe ngaphambilini ukusetshenziswa.
Phakathi kokubheka iphaneli lokubuyekeza:
- Ukusebenza ngokugcwele kwama-ARV omisiwe
- Ukubekezeleliswa kanye nobuthakathaka
- Ukuphepha kwezidakamizwa ekukhulelwe nasesikhathini sokukhulelwa
- Umthwalo wephilisi kanye nokuvama kokulandelwa
Ukuchaza Ukuvezwa Kwezemisebenzi
Ukuvezwa kwe-HIV phakathi kwe-HCP kuchazwa njengokulimala komuntu ngamunye (isib. Isikhwama sokudinga izinwele noma ukusika esicweni esibukhali), noma ukuxhumana kwekhanda lamakhanda noma isikhumba esingenakunyaka (isib. I-chapped, igwetshiwe noma ihlushwa i-dermatitis) ngegazi elinegciwane lesandulela ngculazi , izicubu, noma ezinye izifo zomzimba ezibhekwa njengezifo ezithathelwanayo.
Lokhu kufaka phakathi i-cerebrospinal fluid, i-amniotic fluid, i-pericardial fluid (uketshezi oluvela kumlenze ozungezile ukuzwa), amanzi amanzi ahlanzekile (amanzi aphuma emaphethelweni onke), i-pleural fluid (uketshezi oluvela emagqumeni azungeze amaphaphu); kanye ne-peritoneal fluid (ukucwilisa amanzi okuphuma ngaphakathi kwesigxobo esiswini).
Izindwangu, izimpumputhe zomzimba, umqubu, ukuqhuma, ukujuluka, izinyembezi, umchamo kanye nokuhlanza azibhekwa ukuthi zingase zithatheke ngaphandle uma zibonakala zigazini.
Ngaphezu kwalokho, nakuba ukukhala kwabantu kufanele kuhlolwe ngabanye, akuzange kube khona amacala aqoshiwe okudluliswa kwe-HIV ngokusebenzisa ukulunywa kwabantu endaweni yokunakekelwa kwezempilo.
Izinguquko ezibalulekile ezinkombandlela ze-USPHS
Imikhombandlela yangaphambilini, eyakhishwa ngo-2005, yancoma ukuthi ubukhulu bokuchayeka kufanele buhlolwe ukuze kutholakale ukuthi ngabe ngabe ngabe ngabe kusetshenziswa ama-ARV amabili noma ngaphezulu.
Lezincomo ziye zaphela ngokuphelele, futhi i-USPHS manje ivumela ukusetshenziswa kwama-ARV amathathu noma ngaphezulu kuwo wonke amathuba okuma emsebenzini.
Imihlahlandlela ebuyekeziwe iphakamisa ukuthi ukusetshenziswa kokuhlolwa kwesine-generation antigen / antibody kunganciphisa isikhathi sokuhlolwa kokuphumula ngemuva kwezinyanga eziyisithupha kuya ezinyangeni ezine.
Sibutsetelo Imihlahlandlela
Uma kwenzeka ukutholakala emsebenzini kwe-HIV:
- I-PEP kufanele isetshenziswe ngokushesha, kungakapheli amahora wokuvezwa. Ukubonisana kochwepheshe kufanele kudingeke njalo, kodwa hhayi ngokubambezeleka kokuphuza ukwelashwa.
- Isivivinyo sokuqala se- HIV sizonikezwa ukunquma isimo se-HIV se-HCP. Uma kunokwenzeka, isimo se-HIV somthombo wesifo kufanele sisetshenziswe ukusiza ukuqondisa ukusetshenziswa okufanele kwe-PEP.
- Ama-ARV amathathu noma ngaphezulu angabekwa, ngokusekelwe kuphrofayili yethonya elihle kanye nesimiso esilungile sokufaka isicelo. (Bheka Izinketho Ezidakamizwa Eziphakanyisiwe , ngezansi.) Okwaziwa noma osolakala ukuthi ukukhulelwa (noma ukuncelisa) kuzoqhubeka nokunquma ukhetho lwezidakamizwa kwabanye.
- Ngaphandle kokuhlolwa kokuqala kwegciwane lesandulela ngculaza, i-HCP kufanele inikezwe izivivinyo ezidingekayo zokuhlola izivivinyo ukuze zibheke izidakamizwa ezidakamizwa. Ukuhlolwa kufanele kufake, okungenani, inani eliphelele legazi (i-CBC), kanye nokuhlolwa komsebenzi wezinso nesibindi.
- I-PEP izoqala futhi iqhubeke phakathi nezinsuku ezingama-28. Ukululekwa kwangaphambi kokwelapha kufanele kunikezwe ukubhekana nokunamathela okufanele , imiphumela emibi, kanye nokusebenzisana kwezidakamizwa.
- Ama-aphoyintimenti okulandelwayo kufanele aqale ngaphakathi kwamahora angu-72 okuvezwa, futhi afaka ukulandela ukuhlolwa kwe-HIV nokwelulekwa. Ukuqapha kwelebhu yesibili kwezidakamizwa ezidakamizwa kufanele kwenziwe emavikini amabili.
- Emva kwalokho, ukuhlolelwa i-HIV kufanele kwenziwe emavikini ayisithupha, amasonto angu-12, nezinyanga eziyisithupha emva kokuchayeka. Uma inhlanganisela yesine yesandulela-ngculazi i-HIV p24 i-antigen / HIV isandulela ngculazi isetshenziswe, ukuhlolwa okulandelwayo kungenziwa emavikini ayisithupha nezinyanga ezine ngemuva kokuvezwa.
Izinketho Ezidakamizwa Eziphakanyisiwe
I-USPHS iphakamisa ukusebenzisa i-Viread (tenofovir) ne-Emtriva (emtricitabine) -kuhlanganiswa kwezidakamizwa ezimbili ekubunjweni kwe-single- pilill , i- Truvada -plus Isentress (raltegravir) ye-PEP emithonyeni yokuvezwa komsebenzi.
Ezinye izindlela eziphathelene nalezi zidakamizwa zingasetshenziswa uma kwenzeka isifo sofuba esisodwa noma ezinye izimo ezingase ziphikisana nokusetshenziswa kwemithi ephakanyisiwe.
I-Viramune (i-nevirapine) akumele ibekelelwe i-PEP, kuyilapho ama-ARV engavunyelwe ngaso sonke isikhathi i-PEP kufanele agwenywe. Lokhu kufaka i- Videx (didanosine) ne- Aptivus ( tipranavir ), kanye nokuhlanganiswa kwe-Zerit (stavudine) ne-Videx.
> Umthombo:
> Kuhar, D .; I-Henderson, D .; I-Struble, K .; et al. "Kubuyekezwe Izinkombandlela Zesevisi Zempilo Yomphakathi e-US yokuphathwa kwama-Occupational Exposures to Virus Human Immunodeficiency Virus kanye Nencomo Ze-Postexposure Prophylaxis." Ukulawulwa Kwezifo Ne-Epidemiology Yezibhedlela. Agasti 6, 2013; 34 (9): 875-892.